Weekly Chest CasesArchive of Old Cases

Case No : 786 Date 2012-11-21

  • Courtesy of Gong Yong Jin / Chonbuk National University Hospital
  • Age/Sex 62 / F
  • Chief Complaintdry mouth and dry eye
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Pulmonary amyloidosis, nodular form
Radiologic Findings
Chest PA shows multiple variable sized nodules with small calcification. Chest CT with lung setting shows multiple variable sized nodules with random distribution. Chest CT with enhancement shows mild homogeneous enhancement with amorphous calcifications. PET/CT shows mild hypermetabolism in some pulmonary nodules. H-E shows masses of amorphous, eosinophilic extracellular materials. Congo red-stained section viewed under polarizing microscopy demonstrates apple-green birefringence.
Brief Review
Amylodosis is a generic term for a heterogeneous group of disorders characterized by accumulation of various insoluble fibrillar proteins(amyloid). Amyloidosis is rare and it affects the respiratory tract in approximately 50% of cases. Amyloid may involve the trachea, the bronchi, or more commonly the lung parenchyma. The nodular Amyloid usually is asymptomatic and is found incidentally on the chest radiograph.
Nodular parenchymal amyloidosis is manifested as solitary or, less commonly, multiple nodules usually ranging from 0.5 to 15 cm in diameter. The nodules occur most commonly in the lower lobes and are usually peripheral. Disease may progress slowly during a period of several years. Calcification is seldom evident on radiographs but is seen in 20% to 50% of nodules on CT scans. Nodular amyloid deposits have been commonly in patients with Sj흷gren syndrome and lymphoid interstitial pneumonia. The main differential diagnosis is primary or metastatic tumors.
References
1.Gillmore JD, Hawkins PN. Amyloidosis and the respiratory tract. Thorax 1999;54:444-451
2.Utz JP, Swensen SJ, Gertz MA. Pulmonary amyoidosis. The Mayo Clinic experience from 1980 to 1993. Ann Intern Med 1996;124:407-413
Keywords
lung, metabolic ans storage,

No. of Applicants : 103

▶ Correct Answer : 49/103,  47.6%
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - XiangYa hospital , China Xia Yu
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - University of British Columbia , Canada Amr Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Saint Malo , France jean-baptiste Noel
  • - Kyung Hee University Hospital at Gangdong , Korea (South) Koo Soo
  • - McGill university , Canada Badriya Al-qassabi
  • - CH de la C�te Basque , France Paul ARDILOUZE
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Az Osp Santa Maria Terni , Italy angelo carloni
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Myongji , Korea (South) Moon soon young
  • - Kyung Hee Universitiy Hospital at Gangdong , Korea (South) Seong Jong Yun
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - All India Institute of medical sciences , India Justin Moses
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - McGill University , Canada Mike Perillo
  • - Radnet Teleradiology Istanbul , Turkey Armagan Sarac
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - Himeji St.Mary Hospital , Japan Yuichiro Kanie
  • - Centre Hospitalier Lyon Sud , France matthieu ROUSSET
  • - CHU Poitiers , France CHAN paul
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan medical center , Korea (South) Cherry Kim
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - H�pital du Sacr , Canada Andrea Ojanguren
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - Chungbuk national university hospital , Korea (South) Jisun Lee
  • - CHRU Lille , France Paul Lebert
  • - , Korea (South) Sanghyuk Ahn
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - HIA Legouest - METZ , France Alban Gervaise
  • - Columbia Asia , India John Joseph
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - , Korea (South) Chan Park
  • - Saga University , Japan Ryoko Egashira
  • - SNUH , Korea (South) Euijin Hwang
▶ Correct Answer as Differential Diagnosis : 12/103,  11.7%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Health sinces university of mongolia , Mongolia bakhytnur khuanysh
  • - GM InHospital , Korea (South) Ju Won Lee
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - AUBMC , Lebanon Mouhamad Nasser
  • - royal melbourne hospital , Australia kimchi kings
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - HUEC , Brazil Diogo Pinheiro
  • - Chungbuk University Hospital , Korea (South) Yunhee Jang
  • - , Korea (South) Choong-Ki Park
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Kyungpook National University Hospital , Korea (South) Jaekwang Lim
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